Thank you for choosing to register for the Local Anesthesia for the Dental Hygienist Certificate Program. You can begin the registration process below. Please complete all
applicable fields of this form. Required fields are denoted by *.
You are registering for the following course:
Local Anesthesia for the Dental Hygienist Certificate Program
If you have previously completed the "Anticoagulation Therapy Management Certification Program", please enter the year of completion. If you have not previously completed the "Anticoagulation Therapy Management Certification Program", please leave the following section blank.
Proof of graduation from a dental assisting program accredited by the Commission on Dental Accreditation of the American Dental Association or proof of one (1) or more years experience in dental assisting. Employer Dentist must submit a letter on company letterhead verifying experience and include the Dentist signature and daytime phone number for follow-up. Access to the online component of the program will not be granted until the documentation is received and verified. Please fax to Kim Parsons, Program Director at 812-461-5356 (USI CNHP; Attn: Angie Bledsoe) or mailed to the following address:
Dental Assisting ProgramAttn: Kim Parsons, Program Director8600 University BlvdEvansville, IN 47712